Nasal Suctioning Therapy Among Infants With Bronchiolitis Discharged Home From the Emergency Department

Key Points Question What is the effectiveness of enhanced nasal suctioning compared with minimal suctioning in infants with bronchiolitis discharged home from pediatric emergency departments? Findings In this randomized clinical trial of 367 infants, minimal bulb suctioning resulted in significantly higher additional resource use compared with enhanced battery-operated suctioning at 72 hours. There was a nonsignificant difference in unscheduled revisits for bronchiolitis, but minimal suctioning yielded significantly higher use of nonassigned suctioning devices for perceived breathing or feeding difficulties than enhanced suctioning. Meaning Enhanced suctioning after emergency department discharge with bronchiolitis did not alter the disease course compared with minimal suctioning.

For each visit to a doctor for bronchiolitis, please answer the following questions: 2) Since going home from our Emergency Department, has your child been admitted to a hospital (to a hospital ward) for bronchiolitis?

B. FEEDING
Compared to usual, how has your child fed in the past 24 hours?
(Mark your answer by putting X on one of the circles) Prior to randomization and at 72 hours, the parents were asked about their infant's feeding and sleeping adequacy and their own sleeping adequacy over the past 24 hours by asking the following Likert scale questions: Feeding: "In the past 24 hours, how has your child fed compared to usual?" a) normal/almost normal feeding amount (more than about 80% normal bottle intake or no/minimal difficulty breastfeeding), b) below normal feeding but more than ½ usual bottle intake or some difficulty breastfeeding c) feeding very much less than normal (less than ½ usual bottle intake or major difficulty breastfeeding); going home from the Emergency Department (when you/your child started participating in this research study), has your child visited a doctor for bronchiolitis?If NO, please continue to page 2 (Section B. FEEDING) If YES, how many times has your child visited a doctor for bronchiolitis?(choose only one)  One  Two  Three

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In the past 24 hours, how has your child slept compared to usual?" a) very much less than normal, b) less than normal), c) normal/almost normal, d) somewhat more than normal, e) very much more than normal.Parental Sleep:"In the past 24 hours, how have you (the caregiver) slept compared to usual?" a) very much less than normal, b) somewhat less than normal, c) normal/almost normal, d) somewhat more than normal, e) very much more than normal.eAppendix3: Satisfaction With Care After DischargeThe caregivers' satisfaction with their ability to manage their child's illness was measured by their response to the following question: "How would you rate your level of satisfaction with your ability to care for your child while he/she has been sick (since the initial ED visit 3 days ago)?a) very satisfied, b) satisfied, c) neither satisfied nor dissatisfied, d) dissatisfied, e) very dissatisfied.

Feeding and Sleeping Adequacy Questions
How would you or the main caregiver rate your level of satisfaction with your ability to care for your child while he/she has been sick (since the initial Emergency Department visit 3 days ago)?Did any of the following occur immediately after the use of this device?Check all that apply: How satisfied were you with the device you have used in the past 3 days?(Markyour answer by putting X on one of the circles) If you are dissatisfied or very dissatisfied, what are the reasons?Check all that apply: Will you use this same nose suctioning device again in the future?
C. SLEEPINGCHILD (Mark your answer by putting X on one of the circles)Compared to usual, how has your CHILD slept in the past 24 hours?device(s) below to clean your child's nose?(check all that apply): [ ] Zo-Li battery-operated nasal aspirator [ ] Bulb nasal aspirator [ ] Other battery-operated nasal aspirator (specify): _______________________ For example: [ ] Mouth to nose human suction nasal aspirator For example: Hydrasense, Naspira, Nosefrida, or any other similar device.2) How often did you use any of the following suctioning devices in the last 3 days?7) If YES, what problems made you see the doctor?Check all that apply:

eTable 1. Secondary Outcomes of the Trial: Per-Protocol Analyses
a Post hoc adjustment for stratification at randomization for age group, with site as a random effect.bBased on logistic regression analysis c Defined as any unscheduled visit for bronchiolitis to any medical facility or provider within 72 hours of ED discharge d Defined as >80% normal fluid intake e Defined as satisfied or very satisfied with bronchiolitis care after discharge